Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth
MassHealth
Substance Abuse Treatment Center Bulletin 10
August 2013
TO: Community Health Centers Participating in MassHealth
FROM: Kristin L. Thorn, Acting Medicaid Director
RE: Improving Treatment for Substance Use Disorders
Purpose
Improving initiation and engagement of patients who are diagnosed
with substance dependency helps reduce drug-related illnesses
and deaths, overuse of health care services, and economic and
social difficulties associated with substance use disorders.
MassHealth is working to improve the rate that members receive
timely initiation and engagement of treatment for alcohol and other
drug (AOD) dependencies, following identification of an AOD
diagnosis.
This bulletin offers practice tips and resources to help MassHealth
providers support high-quality care and to ensure proper billing of
the services they deliver.
Background
MassHealth managed care plans have collected Healthcare
Effectiveness Data and Information Set (HEDIS) information since
1996. HEDIS performance rates provide a mechanism for
MassHealth to compare scores across health plans and uncover
health care quality improvement opportunities. Although
MassHealth initiation and engagement HEDIS rates have improved
from 2005 to 2011, the current performance rates of 52.7 percent
for initiation and 19.9 percent for engagement suggest room for
statewide improvement.
When a member is diagnosed with AOD, the following two HEDIS
rates are collected.
1. Initiation of Treatment: the percentage of members diagnosed
with AOD that begin treatment either through an inpatient or
outpatient admission or emergency department visit and any
other AOD service within 14 days.
2. Engagement in Treatment: the percentage of members who
complete two AOD services within 30 days after treatment
initiation.
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MassHealth
Substance Abuse Treatment Center Bulletin 10
August 2013
Page 2
Background
(cont.)
Exception: Care that includes a detox code (including those listed
below) does not count toward the initiation or engagement of AOD
treatment.
HCPCS
ICD-9-CM Procedure
UB Revenue
H0008-H0014
94.62, 94.65, 94.68
0116, 0126, 0136,
0146, 0156
Tips for Working with
Your Patient
Improving initiation and engagement of your patients who are
diagnosed with substance dependency helps reduce drug-related
illnesses and deaths, overuse of health care services, and
economic and social difficulties associated with substance use
disorders.
Practice Tips
* Include family members and other people whom your patient
welcomes in support of his or her AOD care.
* Provide written educational material. (For resources, see
below.)
* Use motivational interviewing techniques.
o Express empathy with a warm, nonjudgmental stance,
active listening, and reflecting back what is said.
o Develop discrepancy between the patientís choice to drink
or use drugs and his or her goals, values, or beliefs.
o Roll with resistance by acknowledging the patientís
viewpoint, avoiding a debate, and affirming autonomy.
* Support the patientís belief that he or she can succeed by
expressing confidence and pointing to strengths and past
successes of the patient.
Tips for Your Practice
Visits and Follow-up to Encourage Sobriety
* Each time you identify a patient as having a primary or
secondary diagnosis indicating dependence on alcohol or other
drugs, schedule a follow-up visit within 14 days.
* Contact the patient after the scheduled follow-up visits with a
specialist to ensure that the appointments were kept.
* When notified of a hospital discharge for a patient with an AOD
diagnosis, schedule a follow-up visit within 14 days and refer
the patient to a specialist, or schedule two additional visits
within 30 days.
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MassHealth
Substance Abuse Treatment Center Bulletin 10
August 2013
Page 3
Billing
When treating a member for issues related to an AOD diagnosis, code
the diagnosis on every claim using ICD-9 diagnosis codes from the
series in the following chart.
ICD-9-CM Diagnosis: Codes to Identify AOD
291-292, 303.00-303.02, 303.90-303.92, 304.00-304.02,
304.10-304.12, 304.20-304.22, 304.30-304.32, 304.40-304.42,
304.50-304.52, 304.60-304.62, 304.70-304.72, 304.80-304.82,
304.90-304.92, 305.00-305.02, 305.20-305.22, 305.30-305.32,
305.40-305.42, 305.50-305.52, 305.60-305.62, 305.70-305.72,
305.80-305.82, 305.90-305.92, 535.3, 571.1
Claims with dates of service on and after October 1, 2014, will require
ICD-10 diagnosis codes.
Best-Practice Resources
* Massachusetts Department of Public Health, Bureau of
Substance Abuse Services (BSAS) Principles of Care and
Practice Guidance offers practice improvements in substance use
disorder prevention, treatment, and recovery systems of care.
www.mass.gov/eohhs/gov/departments/dph/programs/substance
abuse/providers/program/-licencing/principles-of-care-and-practice-
guidance.html
* SAMHSA Treatment Improvement Protocol (TIP) Series are best-
practice guidelines for the treatment of substance use disorders.
www.kap.samhsa.gov/products/manuals/tips/index.htm#assessment
Resources of National
Organizations
* National Institute on Drug Abuse (NIDA) supports research to
prevent and treat drug abuse and addiction and mitigate the impact
of their consequences.
www.nida.nih.gov/
* National Institute on Alcohol Abuse & Alcoholism (NIAAA) leads
the national effort to reduce alcohol-related problems by supporting
research.
www.niaaa.nih.gov/
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MassHealth
Substance Abuse Treatment Center Bulletin 10
August 2013
Page 4
Resources of National
Organizations
(cont.)
*
* Health and Human Services (HHS), in collaboration with other
agencies, supports comprehensive prevention campaigns to educate the
public about the dangers of illicit drug use, particularly among youth, and
tracks national substance use disorder patterns through six major
surveys to help the nation to identify potential drug problem areas and
ensure that resources are targeted to areas of greatest need.
www.hhs.gov/
* Substance Abuse and Mental Health Services (SAMHSA) works to
improve the quality and availability of substance use disorder prevention,
alcohol- and drug-addiction treatment, and mental health services.
www.samhsa.gov/
Provider Survey
We would appreciate your completion of a survey created to help us
learn about the usefulness of this bulletin to our providers.
www.surveymonkey.com/s/IET_BulletinSurvey
Questions
If you have questions about the information in this bulletin, please
contact MassHealth Customer Service at 1-800-841-2900, e-mail your
inquiry to providersupport@mahealth.net, or fax the inquiry to
617-988-8974.